Methodology and experiences of rapid advice guideline development for children with COVID-19: responding to the COVID-19 outbreak quickly and efficiently.

BACKGROUND: Rapid Advice Guidelines (RAG) provide decision makers with guidance to respond to public health emergencies by developing evidence-based recommendations in a short period of time with a scientific and standardized approach. However, the experience from the development process of a RAG has so far not been systematically summarized. Therefore, our working group will take the experience of the development of the RAG for children with COVID-19 as an example to systematically explore the methodology, advantages, and challenges in the development of the RAG. We shall propose suggestions and reflections for future research, in order to provide a more detailed reference for future development of RAGs. RESULT: The development of the RAG by a group of 67 researchers from 11 countries took 50 days from the official commencement of the work (January 28, 2020) to submission (March 17, 2020). A total of 21 meetings were held with a total duration of 48 h (average 2.3 h per meeting) and an average of 16.5 participants attending. Only two of the ten recommendations were fully supported by direct evidence for COVID-19, three recommendations were supported by indirect evidence only, and the proportion of COVID-19 studies among the body of evidence in the remaining five recommendations ranged between 10 and 83%. Six of the ten recommendations used COVID-19 preprints as evidence support, and up to 50% of the studies with direct evidence on COVID-19 were preprints. CONCLUSIONS: In order to respond to public health emergencies, the development of RAG also requires a clear and transparent formulation process, usually using a large amount of indirect and non-peer-reviewed evidence to support the formation of recommendations. Strict following of the WHO RAG handbook does not only enhance the transparency and clarity of the guideline, but also can speed up the guideline development process, thereby saving time and labor costs.

Guidelines for the prevention and management of children and adolescents with COVID-19.

Children are the future of the world, but their health and future are facing great uncertainty because of the coronavirus disease 2019 (COVID-19) pandemic. In order to improve the management of children with COVID-19, an international, multidisciplinary panel of experts developed a rapid advice guideline at the beginning of the outbreak of COVID-19 in 2020. After publishing the first version of the rapid advice guideline, the panel has updated the guideline by including additional stakeholders in the panel and a comprehensive search of the latest evidence. All recommendations were supported by systematic reviews and graded using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Expert judgment was used to develop good practice statements supplementary to the graded evidence-based recommendations. The updated guideline comprises nine recommendations and one good practice statement. It focuses on the key recommendations pertinent to the following issues: identification of prognostic factors for death or pediatric intensive care unit admission; the use of remdesivir, systemic glucocorticoids and antipyretics, intravenous immunoglobulin (IVIG) for multisystem inflammatory syndrome in children, and high-flow oxygen by nasal cannula or non-invasive ventilation for acute hypoxemic respiratory failure; breastfeeding; vaccination; and the management of pediatric mental health. CONCLUSION: This updated evidence-based guideline intends to provide clinicians, pediatricians, patients and other stakeholders with evidence-based recommendations for the prevention and management of COVID-19 in children and adolescents. Larger studies with longer follow-up to determine the effectiveness and safety of systemic glucocorticoids, IVIG, noninvasive ventilation, and the vaccines for COVID-19 in children and adolescents are encouraged. WHAT IS KNOWN: • Several clinical practice guidelines for children with COVID-19 have been developed, but only few of them have been recently updated. • We developed an evidence-based guideline at the beginning of the COVID-19 outbreak and have now updated it based on the results of a comprehensive search of the latest evidence. WHAT IS NEW: • The updated guideline provides key recommendations pertinent to the following issues: identification of prognostic factors for death or pediatric intensive care unit admission; the use of remdesivir, systemic glucocorticoids and antipyretics, intravenous immunoglobulin for multisystem inflammatory syndrome in children, and high-flow oxygen by nasal cannula or non-invasive ventilation for acute hypoxemic respiratory failure; breastfeeding; vaccination; and the management of pediatric mental health.

[Workplace Fatigue, Metabolic Syndrome, and Cardiovascular Disease Risks: A Study of Long-Term Night Shift Nurses].

BACKGROUND: Night-shift work affects the physical and mental health of employees. Early identification of relevant high-risk groups may be referenced in health promotion, job analysis, and job design. PURPOSE: To explore the differences in workplace fatigue, physiological index of metabolic syndrome, and risk of cardiovascular disease between long-term and non-long-term night-time working nursing staff. METHODS: The health examination data of 91 long-term and 119 non-long-term night-shift nurses were collected. A sub-data analysis approach was used and t-test, chi-square, Pearson`s correlation, and hierarchical multiple regression were used to conduct statistical analysis. RESULTS: A positive correlation between cardiovascular risk and workplace fatigue was found in the long-term night-shift working group. Moreover, a lower average duration of sleep was found in the non-long-term night-shift working group. Finally, the participants with workplace fatigue and metabolic syndrome were found to have higher levels of cardiovascular risk. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: Nursing staff who work night shifts for long-term and non-long-term periods should all receive regular health check-ups and practice healthy eating, exercise, and sleep habits. Employers should provide regular health checkups to their nursing staff and implement measures to identify health hazards in accordance with laws on labor standards, occupational safety, and health and labor health protection regulations, and then adopt appropriate plans and necessary safety and health measures to achieve a mutually beneficial result for both employers and employees in the healthcare industry.

Culturally Tailored Intervention to Promote Mammography Screening Practice Among Chinese American Women: a Systematic Review.

Our review aimed to assess the effectiveness of culturally tailored intervention in mammography practice for Chinese American women. We searched the entire paper published by the Cochrane Library, PubMed, and Web of Science from inception to 17 October 2019. Moreover, we manually checked reference lists of included studies to find other potentially eligible studies. It included clinical trials published in English that evaluated the effects of culturally tailored intervention on mammography practice for Chinese American women. Finally, we involved eight studies in our review. After the intervention, the mammography intention and breast cancer-related knowledge were significantly improved. However, there was no significant impact on mammography completion rate, perceived susceptibility, perceived seriousness, perceived benefits, perceived barriers, and Eastern cultural views of Chinese American women. The culturally tailored interventions could serve as promising approaches to improve mammography screening practice for Chinese American women, but further improvements are needed.

[The Study of the Relationship Between Community Social Capital and Quality of Life among the Middle-aged and Elderly Rural-to-Urban Residents].

OBJECTIVE: To analyze the relationship between community social capital and quality of life among the middle-aged and elderly rural-to-urban residents, and to provide the policy reference for improving the health status. METHODS: A multi-stage random sampling method was used to select the research objects. Univariate analysis and logistic regression model were used to explore the effect of social capital on quality of life among the middle-aged and elderly rural-to-urban urbanized residents. RESULTS: The scores of self-rated physical health and mental health in the rural-to-urban residents were lower than those of urban residents ( P<0.05). The total score of community social capital, community participation and community cohesion in the rural-to-urban residents were lower than those of urban residents ( P<0.05). The result of multivariate analysis showed that community attachment and community cohesion were the protective factors of physical health ( P<0.05), and community cohesion was the protective factor of mental health ( P<0.05). CONCLUSION: There is a correlation between community belonging, community cohesion and quality of life among the elderly rural-to-urban residents. Attention should be paid to the promotion of community social capital so as to improve the health status of middle-aged and elderly rural-to-urban residents.

A Visibly Observable, Programmable Supramolecular Logic Platform and Its Application in Smart Thiols Sensing.

Molecular computation is increasingly attractive as a tool for medical and biological research because of its programmability and controllability. Herein, a novel visibly observable supramolecular system that can execute multi-level logic functions on a uniform platform was constructed. By employing some programming factors, we succeeded in not only constructing a whole set of contrary logic pairs, but also building up a logic network that can implement advanced functions. Further, the platform is applied to sense thiols in specific environments. The developed method can efficiently filter signals of thiols in intracellular conditions and measure cysteine levels quantitatively in serum conditions. The visual readout makes the method particularly suitable for point-of-care testing. The supramolecule-based platform illustrates not only an incremental advance for the construction of programmable molecular logic systems, but also viable applications in intelligent thiol analysis.

Technologies for enhancement of bioactive components and potential health benefits of cereal and cereal-based foods: Research advances and application challenges.

Cereal grains are a major source of human food and their production has steadily been increased during the last several decades to meet the demand of our increasing world population. The modernized society and the expansion of the cereal food industry created a need for highly efficient processing technologies, especially flour production. Earlier scientific research efforts have led to the invention of the modern steel roller mill, and the refined flour of wheat has become a basic component in most of cereal-based foods such as breads and pastries because of the unique functionality of wheat protein. On the other hand, epidemiological studies have found that consumption of whole cereal grains was health beneficial. The health benefit of whole cereal grain is attributed to the combined effects of micronutrients, phytochemicals, and dietary fibre, which are mainly located in the outer bran layer and the germ. However, the removal of bran and germ from cereal grains during polishing and milling results in refined flour and food products with lower bioactive compounds and dietary fibre contents than those from whole grain. Also, the level of bioactive compounds in cereal food is influenced by other food preparation procedures such as baking, cooking, extrusion, and puffing. Therefore, food scientists and nutritionists are searching for strategies and processing technologies to enhance the content and bioavailability of nutrients, bioactive compounds, and dietary fibre of cereal foods. The objective of this article was to review the research advances on technologies for the enhancement of bioactive compounds and dietary fibre contents of cereal and cereal-based foods. Bioactivities or biological effects of enhanced cereal and cereal-based foods are presented. Challenges facing the application of the proposed technologies in the food industry are also discussed.

Neuroprotective Mechanisms of Melatonin in Hemorrhagic Stroke.

Hemorrhagic stroke which consists of subarachnoid hemorrhage and intracerebral hemorrhage is a dominant cause of death and disability worldwide. Although great efforts have been made, the physiological mechanisms of these diseases are not fully understood and effective pharmacological interventions are still lacking. Melatonin (N-acetyl-5-methoxytryptamine), a neurohormone produced by the pineal gland, is a broad-spectrum antioxidant and potent free radical scavenger. More importantly, there is extensive evidence demonstrating that melatonin confers neuroprotective effects in experimental models of hemorrhagic stroke. Multiple molecular mechanisms such as antioxidant, anti-apoptosis, and anti-inflammation, contribute to melatonin-mediated neuroprotection against brain injury after hemorrhagic stroke. This review article aims to summarize current knowledge regarding the beneficial effects of melatonin in experimental models of hemorrhagic stroke and explores the underlying mechanisms. We propose that melatonin is a promising neuroprotective candidate that is worthy of further evaluation for its potential therapeutic applications in hemorrhagic stroke.

Elevated Matrix Metalloproteinase-9 Expression Correlates With Advanced Stages of Oral Cancer and Is Linked to Poor Clinical Outcomes.

PURPOSE: Using a meta-analytic approach, the relation between increased matrix metalloproteinase-9 (MMP-9) expression, tumor stage, and clinical outcomes in oral cancers was investigated. MATERIALS AND METHODS: Multiple English- and Chinese-language electronic databases were searched to identify high-quality case-and-control studies relevant to this meta-analysis. Methodologic quality of the included trials was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology statement to ensure consistency in reviewing and reporting the results. Statistical analyses were carried out with STATA 12.0 statistical software. RESULTS: Nine case-and-control studies containing a combined total of 419 patients with oral cancer were included in the present meta-analysis. Results showed that patients who were positive for MMP-9 expression had a significantly poorer overall survival compared with those negative for MMP-9 (effect size = 2.10; 95% confidence interval, 0.98 to 3.22; P < .001). MMP-9 expression also positively correlated with lymph node metastasis and advanced T-stage groups (P < .05 for all comparisons). Further, high MMP-9 expression level correlated with increased oral cancer risk in Asians (P < .05 for all comparisons) as shown by method-stratified subgroup analysis. CONCLUSION: The present results strongly suggest that MMP-9 expression level influences tumor invasion and metastasis in oral cancers. Based on these results, MMP-9 can be an excellent therapeutic target in patients with oral cancer.

The benefit of early rehabilitation following tendon repair of the hand: A population-based claims database analysis.

STUDY DESIGN: A retrospective cohort. INTRODUCTION: The benefits of early rehabilitation after hand tendon repair have not been analyzed using population-based datasets. PURPOSE OF THE STUDY: to analyze whether early rehabilitation reduces the resurgery risk and the use of rehabilitation resources. METHODS: Patients (n = 1219) who underwent hand tendon repairs followed by rehabilitation were identified from a nationwide claims database and divided into 3 groups: early (<1 wk after tendon repair), intermediate (1-6 wk), or late (>6 wk) rehabilitation. The resurgery rate and the use of rehabilitation resources after tendon repair were calculated. Cox proportional hazards models were used to evaluate the relevant predictors of resurgery. RESULTS: The early rehabilitation group exhibited the lowest resurgery rate and used the fewest rehabilitation resources. Compared with late rehabilitation, early or intermediate rehabilitation conferred protective effects against resurgery in patients without a concomitant upper-limb fracture. CONCLUSION: Our findings suggest the benefit of early rehabilitation after hand tendon repair. LEVEL OF EVIDENCE: 4.

Versatility of reverse sural fasciocutaneous flap for reconstruction of distal lower limb soft tissue defects.

In this study we present our experiences with the reverse sural fasciocutaneous flap to reconstruct the distal lower limb soft tissue defects caused by traumatic injuries. These flap graftings were carried out from Oct. 2010 to Dec. 2012 in our department. The series consisted of 36 patients, including 21 men and 15 women with an average age of 46.2 years (14-83 years) and with a medium follow-up period of 18 months (12-24 months). Of all the cases of acute trauma, there were 10 cases of trauma of distal tibia, 9 cases of trauma of perimalleolus, and 17 cases of trauma of midfoot and forefoot. Related risk factors in the patients were diabetes (2 cases), advanced age (>65 years, 3 cases) and cigarette smoking (6 cases). The reverse flow sural island flap irrigation depended on lower perforators of the peroneal artery. The fasciocutaneous pedicle was 3-4 cm in width and the anatomical structures consisted of the superficial and deep fascia, the sural nerve, short saphenous vein, superficial sural artery together with an islet of subcutaneous cellular tissue and skin. The most proximal border of the flap was only 1.5 cm away from the popliteal skin crease and the pivot point was 5-7 cm above the tip of the lateral malleolus. All the flaps survived. No arterial crisis occurred in any case. The venous congestion occurred in 2 cases and got better after raising the limbs and bloodletting. Only in an old man, 1.5 cm necrosis of distal margin of his flap occurred and finally healed after continuous dressing change. One-stage skin grafting was performed, and all the donor sites were sutured and successfully healed. It was concluded that the reverse sural fasciocutaneous flap is safe and reliable to extend to the proximal third even near the popliteal skin crease. We also concluded this flap can be safely and efficiently used to treat patients with large and far soft-tissue defects from the distal leg to the forefoot with more versatility and it is easier to reach the recipient sites.

Clinical analysis of 73 cases of intraspinal nerve sheath tumor.

Seventy-three patients with spinal nerve sheath tumor who were surgically treated in our hospital during the years 2004-2010 were retrospectively reviewed with respect to recovery of neurological function, recurrence of the tumor and occurrence of kyphotic deformities. Preoperative clinical manifestations, imaging data, surgical records and follow-up results were comprehensively analyzed. The follow-up duration was 12-60 months with an average of 32.0 months. Out of the 73 cases enrolled, 69 had gradual recovery of sensation, motor and sphincter functions 1 week to 3 months after operation. Forty-six cases had incomplete paralysis, whose American Spinal Injury Association (ASIA) grades, however, were gradually increased during the follow-up period, 4 cases had no significant improvement of the clinical symptoms and no change in ASIA grades during the follow-up period. Two cases had postoperative recurrence of the tumor. There were no deaths, no spinal instability, and no kyphotic malformations found in any cases. Our study indicated that complete removal of the tumor is important for good recovery, and an ideal surgical method may reduce the recurrence of the tumor or the occurrence of complications.

The mediating and moderating role of personal strain and coping resource in the relationship between work stressor and quality of life among Chinese nurses.

OBJECTIVE: To determine whether personal strain and coping resources act as either mediator or moderator or both in the relationship between work stressor and quality of life among Chinese nurses. METHODS: A total of 1,012 nurses were selected from eight hospitals located in two provinces in China. Quality of life was measured with the Chinese version of the Short Form-36 Health Survey; work stressor, personal strain, and coping resources were evaluated using the Occupation Stress Inventory-Revised Edition. The hierarchical multiple regression procedure and Baron and Kenny's model of mediation were applied to test for moderation and mediation, respectively. A structural equation model was fit to assess the interrelationships among these variables. RESULTS: Work stressor was closely associated with quality of life, which was mediated and moderated by personal strain and coping resources. Personal strain also acted both as moderator and mediator in the relationship between coping resources and quality of life. The relationships were verified in the structural equation model. The greatest absolute value of the standardized total effects was seen in personal strain (0.817), followed by work stressor (0.634) and coping resources (0.488). CONCLUSIONS: Personal strain and coping resources have both mediating and moderating effects on the relationship between work stress and quality of life in a sample of Chinese nurses. An effective intervention strategy is needed to reduce work stress and ensure better quality of life.

How to Make Primary Healthcare More Popular: Evidence from the Middle-Aged and Elderly in China.

Since 2001, China has been an aging society; it is expected to become superaged by 2033. This rapid aging trend poses a challenge to the elderly regarding their pension services and healthcare. Primary healthcare has great potential for serving older adults in the community, yet it is not popular. This study used 1977 samples from the 2018 China Health and Retirement Longitudinal Study database to explore the use of outpatient services in primary care institutions among the middle-aged and elderly. Using a structural equations model, we constructed a framework to explore pathways leading to primary outpatient use. We discovered that the supply of primary health services had a significant direct and mediating effect on the utilization of primary outpatient services, and that community pension services may indirectly discourage it. In addition, the supply of primary health services has a suppressor effect between medical insurance and primary outpatient utilization. Health insurance directly promotes primary outpatient utilization, while the supply of primary care institutions suppresses the positive influence of medical insurance on the utilization of primary outpatient services. Therefore, community pension services should pay attention to differentiated services. Moreover, adjusting the coordinated development of medical insurance and the supply of primary healthcare could enhance the positive effects of medical insurance for outpatients.

Exploring the Impacts of Preventative Health Behaviors with Respect to COVID-19: An Altruistic Perspective.

This study aims to explore the impact of gender and anxiety on various preventative health behaviors, and the relationships among these preventative health behaviors, individual well-being and depression, from the perspective of altruism. This study employed an online questionnaire survey, and 136 males and 204 females participated in the survey. The results of this study showed that females exhibited better preventative health behaviors than males, including hygiene habits, social distancing and behaviors intended to help others mitigate the epidemic. Anxiety regarding COVID-19 infection encouraged individuals to adopt hygienic habits and social distancing measures rather than to help others mitigate the epidemic. Hygiene habits improved the individual's psychological well-being. Helping others mitigate the epidemic improved the individual's psychological well-being and social well-being and contributed to reducing individual depression. However, the preventative health behavior involved in social distancing was not conducive to emotional well-being or social well-being. Affective elements are related to individual behaviors. Therefore, the use of prosocial, altruistic language may play an important role with respect to encouraging people to comply with preventative health behaviors in the context of COVID-19. In addition, it is worth noting that different preventative health behaviors may have different effects on people's mental health, especially when implementing social distancing-related epidemic mitigation behaviors. The question of how to prevent negative psychological effects in restricted actors must be answered, and the degree of life satisfaction experienced by those actors must also be taken into account.

Predictors for self-discontinuation of anti-osteoporosis medication: A hospital-based real-world study.

Osteoporotic fractures have a tremendous impact on quality of life and may contribute to fatality, but half of patients may discontinue their anti-osteoporosis medication. The study aimed to investigate the factors associated with the persistence of anti-osteoporosis medication. Between June 2016 and June 2018, we recruited 1195 participants discontinuing prior anti-osteoporosis medication. Telephone interviews were conducted to discern the reasons for discontinuation. Comparisons among groups and risks of self-discontinuation were analyzed. Among 694 patients who have no records of continuing anti-osteoporosis medication, 374 (54%) self-discontinued, 64 (9.2%) discontinued due to physicians' suggestion, and 256 (36.8%) with unintended discontinuation. Among patients with self-discontinuation, 173 (46.3%) forgot to visit outpatient clinics; 92 (24.5%) discontinued because of medication-related factors; 57 (15.2%) thought the severity of osteoporosis had improved and therefore discontinued; 30 (8%) stopped due to economic burden; 22 (5.9%) were lost to follow-up because of newly diagnosed diseases other than osteoporosis. Additionally, older age, male gender, calcium supplement, teriparatide therapy and hip fractures in teriparatide users were associated with adherence to anti-osteoporosis drugs. In conclusion, our results indicate that younger age, female gender, non-use of calcium supplements, and anti-resorptive medication were independent risk factors associated with drug discontinuation. Identifying high-risk patients and providing timely health education are crucial for adherence to anti-osteoporosis medication.

Vascular compression syndrome of sciatic nerve caused by gluteal varicosities.

Sciatica is defined as pain or discomfort along the regions innervated by the sciatic nerve. Compression or irritation of lumbar spinal roots, most commonly because of lumbar disc herniation or spinal stenosis, causes sciatica in the vast majority of cases. Although it is rather uncommon, many pathologies have reported to cause nondiscogenic sciatica. A 70-year-old woman presented with intractable sciatic pain which was not elicited by posture change or cough. Sitting on the affected side provoked more pain than standing or walking. Magnetic resonance imaging revealed both spondylolisthesis with lumbar stenosis and compression of the gluteal portion of the sciatic nerve by varicotic gluteal veins. Given the atypical presentation of spinal root compression, gluteal vascular compressive neuropathy was suspected. Ligation and resection of varicotic vein resulted in relief of the patient's pain. To our knowledge, cases with varicosity-caused sciatica were limited in the literature review.

Five Questions for Residency Leadership in the Time of COVID-19: Reflections of Chief Medical Residents From an Internal Medicine Program.

The COVID-19 pandemic has drastically affected the traditional methods residency programs use to train their residents. Chief residents serve a unique role as part of the residency leadership to foster the education and development of the residents. Given the rapid shift in demands on physicians in the face of the pandemic, the responsibilities of the chief residents have also shifted to help prepare the residents to meet these demands as frontline providers. There is not a precedent for how residency programs respond to this crisis while maintaining their primary role to develop and train physicians. The authors have identified 5 questions chief residents can ask to guide their program's response to the demands of COVID-19 during this uncertain time in health care.

Plantar fasciitis in physicians and nurses: a nationwide population-based study.

Physicians and nurses in Taiwan have heavy workload and long working hours, which may contribute to plantar fasciitis. However, this issue is unclear, and therefore, we conducted this study to delineate it. We conducted a nationwide population-based study by identifying 26,024 physicians and 127,455 nurses and an identical number of subjects for comparison (general population) via the National Health Insurance Research Database. The risk of plantar fasciitis between 2006 and 2012 was compared between physicians and general population, between nurses and general population, and between physicians and nurses. We also compared the risk of plantar fasciitis among physician subgroups. Physicians and nurses had a period prevalence of plantar fasciitis of 8.14% and 13.11% during the 7-yr period, respectively. The risk of plantar fasciitis was lower among physicians (odds ratio [OR]: 0.660; 95% confidence interval [CI]: 0.622-0.699) but higher among nurses (OR: 1.035; 95% CI: 1.011-1.059) compared with that in the general population. Nurses also had a higher risk than the physicians after adjusting for age and sex (adjusted odds ratio [AOR]: 1.541; 95% CI: 1.399-1.701). Physician subspecialties of orthopedics and physical medicine and rehabilitation showed a higher risk. Female physicians had a higher risk of plantar fasciitis than male physicians. This study showed that nurses, physician specialties of orthopedics and physical medicine and rehabilitation, and female physicians had a higher risk of plantar fasciitis. Improvement of the occupational environment and health promotion are suggested for these populations.